<extend name="Base/common"/>
<block name="style">



</block>


<block name="body">

    <h4 align="center" style="margin-top: 5px;">请正确填写如下信息</h4>
    <!--填写包车信息表单-->
    <!--出发到达地和时间表单-->
    <div class="weui-cells weui-cells_form">
        <div class="weui-cell">
            <div class="weui-cell__hd"><label class="weui-label">出发地</label></div>
            <div class="weui-cell__bd">
                <input class="weui-input" type="text" placeholder="请输入出发地点">
            </div>
        </div>
        <div class="weui-cell">
            <div class="weui-cell__hd"><label class="weui-label">目的地</label></div>
            <div class="weui-cell__bd">
                <input class="weui-input" type="text" placeholder="请输入目的地点">
            </div>
        </div>
        <div class="weui-cell">
            <div class="weui-cell__hd"><label for="" class="weui-label">出发日期</label></div>
            <div class="weui-cell__bd">
                <input class="weui-input" type="date" value="">
            </div>
        </div>
    </div>
    <!--出发到达地和时间表单结束-->
    <!--姓名和电话表单-->
    <div class="weui-cells weui-cells_form">
        <div class="weui-cell">
            <div class="weui-cell__hd"><label class="weui-label">姓名</label></div>
            <div class="weui-cell__bd">
                <input class="weui-input" type="text" placeholder="请输入姓名">
            </div>
        </div>
        <div class="weui-cell">
            <div class="weui-cell__hd"><label class="weui-label">电话</label></div>
            <div class="weui-cell__bd">
                <input class="weui-input" type="number" placeholder="请输入电话">
            </div>
        </div>
    </div>
    <!--姓名和电话表单结束-->
    <!--团报人数和团报方式表单-->
    <div class="weui-cells weui-cells_form">
        <!--团报人数表单-->
        <div class="weui-cell">
            <div class="weui-cell__hd"><label class="weui-label">团报人数</label></div>
            <div class="weui-cell__bd">
                <input class="weui-input" type="number" placeholder="请输入具体人数">
            </div>
        </div>
        <!--团报人数表单结束-->
        <!--选择单程和往返表单-->

        <div class="weui-cells weui-cells_radio">
            <label class="weui-cell weui-check__label" for="x11">
                <div class="weui-cell__bd">
                    <p>单程</p>
                </div>
                <div class="weui-cell__ft">
                    <input type="radio" class="weui-check" name="radio1" id="x11">
                    <span class="weui-icon-checked"></span>
                </div>
            </label>
            <label class="weui-cell weui-check__label" for="x12">

                <div class="weui-cell__bd">
                    <p>全程</p>
                </div>
                <div class="weui-cell__ft">
                    <input type="radio" name="radio1" class="weui-check" id="x12" checked="checked">
                    <span class="weui-icon-checked"></span>
                </div>
            </label>
        </div>

        <!--团报人数和团报方式表单结束-->
        <!--备注-->
        <div class="weui-cell">
            <div class="weui-cell__bd">
                <textarea class="weui-textarea" placeholder="请输入备注" rows="2"></textarea>
                <div class="weui-textarea-counter"><span>0</span>/200</div>
            </div>
        </div>
    </div>
    <!--备注结束-->
    <!--确认按钮-->
    <div class="submit" style="margin-top: 20px;">
        <a href="javascript:;" class="weui-btn weui-btn_primary" style="width: 300px; border-radius: 90px;">确认</a>
    </div>


</block>